Are QT interval changes during exercise governed by intrinsic heart rate or extrinsic factors, and can this relationship be used to design a physiologically adaptive pacemaker?
QT interval shortening during exercise is largely driven by factors extrinsic to heart rate, enabling the conceptualization and design of a novel physiologically adaptive pacemaker based on stimulus-evoked T wave intervals.
The relation between QT interval and heart rate has been studied in a group of patients undergoing physiological exercise, in a group undergoing atrial pacing without exercise, and in a group with complete heart block undergoing exercise at a fixed ventricular rate controlled by cardiac pacing. The expected shortening in QT interval during physiological exercise is only in part the result of the intrinsic effect of increased rate, since patients undergoing atrial pacing to comparable rates show only a small decrease in measured QT interval and patients exercising at fixed rates in heart block exhibit a decreasing QT interval related to the independent atrial rate. QT interval changes appear mainly to be governed by factors extrinsic to heart rate. The physiological control of QT interval has been used to construct a cardiac pacemaker which senses the interval between the delivered stimulus and the evoked T wave, and uses the stimulus-evoked T wave interval to set the subsequent pacemaker escape interval. Thus physiological control of cardiac pacing rate, independent of atrial activity, using conventional unipolar lead systems is possible.
Rickards et al. (Thu,) studied this question.
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